摘要
目的探讨即时流量测定(transit-time flow measurement,TTFM)在冠状动脉旁路移植术早期移植失败预测中的应用价值。方法行冠状动脉旁路移植术患者102例,术中均行TTFM。术后3个月行冠状动脉CT血管造影检查桥血管,并依据检查结果将其分为正常组(桥血管任何位置出现<50%的狭窄)和狭窄组(桥血管任何位置有≥50%的狭窄或闭塞)。比较2组TTFM参数,ROC曲线分析TTFM参数预测左、右冠状动脉旁路移植术早期移植失败的效能。结果共吻合桥血管331支,桥血管移植至左冠状动脉247支,其中正常220支、狭窄27支,桥血管移植至右冠状动脉84支,其中正常72支、狭窄12支;桥血管移植至左、右冠状动脉时,狭窄组平均流量(mean flow,Q mean)[(16.67±5.09)、(20.25±6.67)mL/min]、舒张期血液供应(diastolic flow,DF)比率[(58.30±9.16)%、(59.08±7.75)%]均低于正常组[Qmean:(47.21±17.39)、(51.49±13.96)mL/min;DF比率:(70.62±8.18)%、(74.47±5.17)%],搏动指数(pulse index,PI)(4.72±0.75、4.42±1.01)高于正常组(2.27±0.79、2.17±0.71)(P<0.05);ROC曲线分析结果显示,Qmean以18.0、24.0mL/min为最佳截断值,预测左、右冠状动脉旁路移植术早期移植失败的AUC分别为0.85(95%CI:0.78~0.92,P<0.001)、0.86(95%CI:0.80~0.93,P<0.001),灵敏度分别为82.0%、83.0%,特异度分别为94.7%、92.6%;PI以4.0、3.7为最佳截断值,预测左、右冠状动脉旁路移植术早期移植失败的AUC分别为0.68(95%CI:0.62~0.71,P<0.001)、0.61(95%CI:0.56~0.67,P<0.001),灵敏度分别为57.2%、54.0%,特异度分别为90.6%、91.5%;DF以65.0%、68.0%为最佳截断值,预测左、右冠状动脉旁路移植术早期移植失败的AUC分别为0.57(95%CI:0.49~0.63,P<0.001)、0.62(95%CI:0.51~0.73,P<0.001),灵敏度分别为52.3%、58.0%,特异度分别为86.3%、85.2%。结论 Qmean<18.0mL/min、PI>4.0、DF<65.0%可预测左冠状动脉旁路移植术早期移植失败,Qmean<24.0mL/min、PI>3.7、DF<68.0%可预测右冠状动脉旁路移植术早期移植失败。
Objective To investigate the value of transit-time flow measurement（TTFM）to predicting early graft failure in coronary artery bypass grafting（CABG）F.Methods In 102 patients undergoing CABG,TTFM tests were performed during operation.According to the CT angiography（CTA）examination of the coronary artery in 3 months after surgery,the bridge blood vessels were divided into normal group（stenosis50% at any location of the bridge blood vessels）and stenosis group（stenosis or occlusion≥50% at any location of the bridge blood vessels）.TTFM indexes were compared between two groups,and ROC curve was used to analyze the efficiency of TTFM indexes on predicting the early graft failure of left and right CABG.Results Totally 331 bridge blood vessels were anastomosed,in which 247 bridge blood vessels were transplanted to left coronary arteries including 220 normal vessels and 27 stenosed vessels,and 84 bridge blood vessels were transplanted to right coronary arteries including 72 normal vessels and 12 stenosed vessels.The mean flow（Qmean）values（（16.67±5.09）,（20.25±6.67）mL/min）and diastolic flow（DF）supply ratios（（58.30±9.16）%,（59.08±7.75）%）of the bridge vessels transplanted into the left and right coronary arteries in stenosis group were significantly lower and the pulse index（PI）values（4.72±0.75,4.42±1.01）were significantly higher than those in normal group（Qmean：（47.21±17.39）,（51.49±13.96）mL/min;DF：（70.62±8.18）%,（74.47±5.17）%;PI：（2.27±0.79,2.17±0.71）（P〈0.05）.ROC curve analysis results showed that when the optimal cut-off values of Qmean were 18.0 and 24.0 mL/min,the AUCs for predicting early graft failure in left and right CABG were 0.85（95%CI：0.78-0.92,P〈0.001）and 0.86（95%CI：0.80-0.93,P〈0.001）,with the sensitivities of 82.0% and83.0% and the specificities of 94.7% and 92.6%,respectively.When the optimal cut-off values of PI were 4.0 and3.7,the AUCs for predicting early graft failure in left and right CABG were 0.68（95%CI：0.62-0.71,P〈0.001）and0.61（95%CI：0.56-0.67,P〈0.001）,with the sensitivities of 57.2% and 54.0% and the specificities of 90.6% and91.5%,respectively.When the optimal cut-off values of DF were 65.0% and 68.0%,the AUCs for predicting early graft failure in left and right CABG were 0.57（95%CI：0.49-0.63,P〈0.001）and 0.62（95%CI：0.51-0.73,P〈0.001）,with the sensitivities of 52.3% and 58.0%,and the specificities of 86.3% and 85.2%,respectively.Conclusion Qmean〈18.0 mL/min,PI〉4.0 and DF〈65.0% could predict the early graft failure in left CABG,while Qmean〈24.0 mL/min,PI〉3.7 and DF〈68.0% could predict the early graft failure in right CABG.
作者
郑居兵
刘韬帅
李扬
赵洋
张魁
董然
ZHENG Ju-bing;LIU Tao shuai;LI Yang;ZHAO Yang;ZHANG Kui;DONG Ran(Department of Cardiac Surgery, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beij ing 100029, China)
出处
《中华实用诊断与治疗杂志》
2018年第7期684-687,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然科学基金(81570373)
